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The authors of this material welcome questions and suggested improvements, which should be sent to: transbullying@gires.org.uk A print friendly version of this document may be found here.
GIRES 2008
Version 2.2.1
February 28, 2010
ACKNOWLEDGEMENTS
The members of the GIRES team who have prepared this guidance, Bernard Reed, Terry Reed and Stephenne Rhodes, wish to thank the many people who have kindly commented on the early drafts of the document and suggested ways to improve it. Commentators have included people working in the Home Ofce and other government agencies, education, the teaching and other unions, the police, trans support groups and other voluntary organisations.The authors value greatly the many personal stories and pictures that transgender people have allowed them to use to illustrate the document. GIRES is also grateful to Kate Craig-Wood, a member of its Executive Committee, whose company, MEMSET, has provided web-hosting facilities for the material during its development phase.
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CHANGE RECORD
Version 2.0 2.1 Change General Release Added Self assessment checklist for schools Added Home Ofce Logo Inserted completely in second sentence on page 7 Inserted suicide warning here Inserted note about counselling service here Inserted note about childs name change here Inserted positive comment from trans mother here Inserted note about school activities here Updated statistics in Appendix F Added Figure F.1 showing number of UK transitioned people Added Figure F.2 showing median age of transition in UK Changed contact email to transbullying@gires.org.uk Added reference to short guides here Added note about uidity of gender identity Added statistic on trans people bullied by teachers Replace breaking by break Added note about uidity of gender identity Clarication of Data Protection Act Added new section on ongoing support Emphasised need to mark and control Memorandum Added warning box and explanation on sample letter New item at front of list of protective measures The Transgender Child cited
2.2
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Executive Summary
During the past decade, transgender issues have become a major component of diversity programmes throughout the public service sector1 . Their present prominence results from continuing rapid growth in the number of transgender people who reveal their gender variance, and substantial strengthening in the laws that support and protect them. Despite the enactment of supportive legislation, transgender people continue to experience widespread discrimination in the educational environment, in the workplace and in society generally. As illustrated by the case examples appended to this toolkit, they are often the victims of transphobic bullying and crime. Bullying, that is not dealt with promptly and effectively can escalate into criminality. As part of its crime reduction programme, the Home Ofce has provided this toolkit to help schools meet their obligation to combat transphobic bullying. For those wishing to obtain a rapid overview of the material, the authors have provided short guides specically for: Governors Head Teachers Teaching Staff Gender variance may be detected in children as young as two: it causes extreme stress for youngsters and their families. This is alone would impair
The glossary of terms in Appendix H may be helpful to those who are unfamiliar with this eld.
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the young persons achievements at school. Bullying severely aggravates this. It is alarming that about a quarter of trans people report having been bullied by their teachers. Transgender members of staff also experience stress, especially if they undertake the transition from the gender role assigned to them at birth to that which accords with their gender identity. They too are the targets for transphobic bullying and crime. In responding to the challenge that transphobic bullying presents, schools need to understand the nature of gender variance, its biological inuences and how it differs from sexual orientation. Importantly, it is not appropriate to think of gender identity as being either totally female or totally male. Sometimes people of any age may be ungendered. In many people, especially those who are young, gender identity may be partially both male and female and also uid. Of course, homophobic bullying, based on a persons actual or perceived sexual orientation, is in many respects similar to transphobic bullying. Moreover in pre-pubertal children, it may be difcult for them or those who care for them to distinguish between uncertainties of gender identity and sexual orientation. However, perpetrators of transphobic bullying and crime do use specic terms of abuse: he/she/it, girl with a cock, that reveals their special hatred for transgender people. Although schools may think that they have no transgender people to worry about, that is statistically unlikely. In any school of 1,000 pupils there are likely to be 6 who will experience transgenderism throughout their lives. There are likely to be others who have a transgender parent or close relative. Among pre-pubertal pupils, there are likely to be 60 in 1,000 who will experience atypical sexual orientation that may be difcult to distinguish from atypical gender identity. There is likely to be one transgender person in 170 members of staff. Unlike people who experience atypical sexual orientation, people who experience severe gender variance require medical care to deal with their condition. Those who are entering puberty may experience intensifying stress, which may have a negative impact on their school work, as their bodies become increasingly discordant with their gender identities. Although major medical centres overseas provide treatment to suspend puberty, that treatment is not available in the UK. Gender variant adults who undertake the transition to a new gender role and receive hormone and surgical treatment to realign their bodies correctly, may require time off work to attend medical appointments, undergo surgery and convalesce.
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Transition is a complex process that requires trans people also to undergo many non-medical changes in the way they live and work, as well as in their relationships. Schools are bound by a general duty to protect all their transgender pupils and staff from transphobic bullying. In the case of staff, there is also a range of specic legislation that requires schools to consider their needs in Gender Equality Schemes and in procedures for handling transition. This toolkit contains guidance for schools on effective ways to support and protect transgender pupils and staff. It also suggests what needs to be done for other staff members. The appendices include a model policy, an example of a letter written to staff about a pupils transition and a selfassessment checklist. Schools need to see that people who transition are able to lead successful and fullling lives and this toolkit therefore includes a number of inspirational role models. Although this toolkit is reasonably comprehensive, schools may need more information than it contains. There are links provided, throughout the text, to external information sources. The nal section of the toolkit indicates where schools can nd further information, advice and training. The document is lengthy. School governors, head teachers and other teaching staff can obtain quickly a basic understanding of how to tackle transphobic bullying by using the short guides overleaf.
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Contents
1 Introduction 2 The nature of gender variance and transgenderism 3 The difference between gender identity and sexual orientation 4 Gender variance in children and adolescents 5 Typical transphobic responses to gender variance
1 3 7 8 12
6 Support and protection for pupils dealing with transgender issues 15 Teachers conversation with a trans girl . . . . . . . . . . . . . . . 15 Important protective measures for transgender pupils . . . . . . 17 7 Medical care for gender variant young people 8 Children of transgender parents 9 Medical treatment options for gender variant adults 21 26 28
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11 Legal and policy safeguards for transgender people General . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Gender Variant Pupils . . . . . . . . . . . . . . . . . . . . . . . . Pupils Behaviour Outside School . . . . . . . . . . . . . . . . . . Adult Transsexual People . . . . . . . . . . . . . . . . . . . . . . Sex Discrimination Act (1975) . . . . . . . . . . . . . . . . . Genuine Occupational Qualication (GOQ) . . . . . . . . . Criminal Records Bureau . . . . . . . . . . . . . . . . . . . Gender Recognition Act (2004) . . . . . . . . . . . . . . . . The Employment Equality (Sexual Orientation)Regulations (2003) . . . . . . . . . . . . . . . . . . . . . . . . . . Data Protection Act 1998 . . . . . . . . . . . . . . . . . . . Equality Act 2006 . . . . . . . . . . . . . . . . . . . . . . . . Other Transgender Adults . . . . . . . . . . . . . . . . . . . . . . 12 Support and protection for transgender staff 13 Helping other staff members 14 Inspirational role models 15 Case examples Case 1Gender Variant Child (Denise) . . Case 2Transsexual Adolescent (Melissa) Case 3Young Trans Man (Jake) . . . . . Case 4Young Trans Man (Tom) . . . . . . Appendices A Consent to treatment Consent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Parental Responsibility . . . . . . . . . . . . . . . . . . . . . . . . B Model transgender policy C Self assessment checklist for schools
33 33 33 36 37 38 38 39 39 41 41 42 43 45 54 55 58 58 60 62 64 66 67 67 68 69 71
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D Letter to staff
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E Documents to be corrected in a permanent change of gender role 76 F Prevalence, incidence and growth of the transgender population 78 G Sources of further information, advice and training Publications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Useful Links . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Helpful Organisations . . . . . . . . . . . . . . . . . . . . . . . . H Introduction to trangender terminology Bibliography Index 81 81 81 82 88 92 95
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1
Introduction
Transgenderism is a new subject for many schools. Schools are required to have anti-bullying policies and protect all children who are in any way different. Applying this principle to gender non-conforming young people requires some specialist knowledge. The purpose of this document is to provide this guidance. This and the other related terms used in this document are therefore explained in the appended Glossary of Terms. In surveys of transgender people, they frequently report having been bullied at school. They also suffer verbal and physical abuse as adults, although very few report these hate crimes to the police. The case examples in the Toolkit include verbal abuse, violence and sexual assault. In many instances, these are of sufcient gravity to be classed as criminal offences. This form of bullying is termed transphobic because it is based on hatred. Transphobic bullying may be perpetrated by pupils or staff members and directed at: a Transgender children and adolescents. b Children of transgender people. c Transgender teachers and other members of staff d Transgender people in the community. Ignorance and fear may underlie transphobia. Hence, this toolkit provides schools with knowledge about the way that gender variance occurs naturally within the general population. As stated in legislation and guidance, schools have a general duty to protect staff and pupils who are vulnerable to or even experiencing bullying based on their gender variant appearance or behaviour. With regard
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Introduction to transsexual adults i.e. those who intend to undergo, are undergoing or have undergone, under medical supervision, a permanent transition to a new gender role, the legislation is highly specic. Other adults, who experience gender variance but do not undergo transition, do not have specic protection in law. Nonetheless, schools are advised to include all these people as well in their Gender Equality Schemes. Gender variance affects a signicant group among pupils and staff. Appendix F quanties the extent of gender variance in the population. Having for long been invisible, a rapidly growing number of people from within the quite substantial transgender population are now revealing their gender variance. Hence schools need to be prepared to protect a mounting number of them. In complying with their obligations in respect of transgender people, schools require information on their special needs and effective measures to protect them. Therefore, this Toolkit is intended to equip schools with the knowledge of how to prevent or deal with transphobic bullying effectively. If left unchecked, bullying behaviour will often escalate in frequency and seriousness, culminating in criminal acts. Schools need to be mindful how reluctant gender variant people usually are to reveal their transgender status. These highly vulnerable people perceive that this may have unwelcome consequences in a school setting or within their families. To obtain protection against transphobic incidents or crimes these must be reported. In order to report such events the individuals concerned may be obliges to out themselves; they may not wish to do so. This problem is particularly acute within the criminal justice system, which includes the police, the Crown Prosecution Service (CPS) and the Courts. Although the criminal justice system has the policies and the powers necessary to deal with transphobic crimes, it is not a fully effective deterrent. The CPS reports that, in the past, incidents against transgender people have been rarely reported and even more rarely prosecuted[1]. Victims and witnesses often believe either that they may become the subject of a police investigation themselves or that they will be treated disrespectfully.
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The nature of gender variance and transgenderism
Society is often intolerant of people who are perceived as different, so it is important to emphasise that human development is, naturally, very varied. Typically, we are divided by our physical sex appearance into male and female. Our reproductive organs and our brains have distinctly different male and female characteristics. These physical differences describe our sex, whereas gender identity, describes the inner sense of knowing that we are men or women; and gender role describes how we behave in society. Typically, our sex appearance, gender identity and gender role are
These babies are innately predisposed to experience gender discomfort and may become transsexual adults
consistent with each other, so we tend to think of human beings as falling into two distinct categories: boys who become men, and girls who become
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The nature of gender variance and transgenderism women. As soon as the sex of a baby is apparent at birth, it is assumed that the gender identity matches.
Even toys in our society are stereotypically gendered. Children may choose the toys they play with, but the adults around them reinforce the message that there are gender appropriate toys for boys and girls. This is not always deliberate, but the tendency to endorse a binary, boy/girl culture is inescapable. Even teddy bears are not immune. However, a few individuals experience a mismatch. The way they look on the outside does not t how they feel inside. The way they are expected to behave may be quite different from the way they naturally want to behave. This causes a feeling of intense discomfort that is sometimes described as gender dysphoria (dysphoria means unhappiness). This condition is increasingly understood to have its origins before birth. Research studies indicate that small parts of the babys brain progress along a different pathway from the sex of the rest of its body1 . This predisposes the baby to a future mismatch between gender identity and sex appearance. However, every individual is unique; each will experience the gender variance to a different degree, and will respond to social circumstances differently. So, people will express this in a wide variety of ways. Importantly, it is not appropriate to think of gender identity as being totally female or totally male. Sometimes people of any age may be ungendered. In many people especially those who are young, gender identity may be partially both male and female and also uid. The general term that embraces all the varieties of unusual gender expression is transgenderism. Some people in this group will respond to their discomfort by cross-dressing occasionally, or even on a regular, but not continuous basis (Transvestism). Others may live permanently in the gender role which is most comfortable for them, but without seeking any medical treatment. For a few, however, as they grow through childhood, then adolescence and on into adulthood, the discomfort may become more extreme. Nonetheless, many people experiencing gender dysphoria live for many years in
A comprehensive description of the factors that inuence gender variance is contained in the article Atypical Gender DevelopmentA Review[2].
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The nature of gender variance and transgenderism the gender role that society expects of them, until nally, the stress becomes so intolerable that they undergo transition to live permanently according to the opposite gender role. This is usually accompanied by hormone medication and corrective surgery, to bring the body more closely in line with the underlying gender identity. The treatment is very successful in giving people the sense of harmony and authenticity that they seek. Others may be able to achieve sufcient comfort through hormone treatment alone. Those seeking this treatment may be referred to as transsexual people or trans people: including trans men (female to male) and trans women (male to female). Their condition is known as transsexualism. After transition, they should be regarded as ordinary men and women. The transition process enables transsexual people to achieve an authentic expression of the innate gender identity and relieve the stress of having to live a lie. It is important to appreciate that the issue of gender identity is different from sexual orientation, that is whether any individual man or woman is sexually attracted to men, women, or both or, very occasionally, neither. Human gender identity and sexual orientation is varied and complex so it is not wise to categorise people. The number of transgender people within the United Kingdom population is relatively small but signicant: Experiencing some degree of gender discomfort: This may affect 6 in 1,000 people, amounting to about 300,000 people. In the main, they do not seek medical treatment for their discomfort and remain largely invisible to clinicians. Many deal with their feelings by occasional cross-dressing. Experiencing a sufcient degree of gender discomfort to seek medical treatment: The number of people who have sought treatment may be about 10,500 people, possibly 1 in 5,000. About 80% of these people were initially raised as male and the remainder as female. Living full time in a gender opposite to that assigned at birth: The number of people, within that 10,500, who have already undergone transition to live full-time in a different gender role may be about 6,200. The number of adults and young people seeking help has been increasing and this growth trend seems likely to continue for many years.
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The nature of gender variance and transgenderism Currently, about 1,200 additional people are seeking medical help each year to deal with their gender discomfort. Those who do, may be of any age. Some are able to defer seeking medical help until there are in their sixties or seventies. In any case, 95% of them do not do so until they are adults. The reluctance of young people to reveal their gender variance may diminish if schools and families become more supportive and medical care improves. More information on incidence, prevalence and growth is provided in Appendix F.
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3
The difference between gender identity and sexual orientation
Gender identity is the inner sense of knowing that we are men or women. This is completely different from sexual orientation, that is whether any individual man or woman is sexually attracted to men, or women, or both or, very occasionally, neither. Human gender identity and sexual orientation is varied and complex so it is not wise to categorise people in distinctly different boxes. We should rely on individuals to state how they self identify if they so wish. Some men, including trans men, may self-identify as straight (sexually attracted to women), gay (sexually attracted to men), bisexual (sexually attracted to women and men) or asexual (feeling no sexual attraction to anyone). Some women, including trans women, may self identify as straight (sexually attracted to men), lesbian (sexually attracted to women), bisexual (sexually attracted to men and women) or asexual (feeling no sexual attraction to anyone). However, gender identity and sexual orientation are private matters. Many individuals prefer not to be labelled at all. The number of people who are gay, lesbian or bisexual may comprise about 5% of the population; that would be 100 pupils in a school of 2,000 (see Appendix F ).
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4
Gender variance in children and adolescents
Gender discomfort may be detected, albeit rarely, in children aged as young as two. Usually, adult transsexual people describe feelings of gender discomfort that date back to their early childhood. These feelings may often have been repressed as a result of overt or perceived nonacceptance by family members and peers. Transsexual people often regret that they were not treated at the onset of puberty, when they experienced intense stress as their bodies began to develop in conict with their core gender identitiestheir inner sense of being boys or girls. During puberty, transsexual boys develop breasts, start to menstruate and sometimes become frustrated by their small stature. Transsexual girls voices deepen, they grow facial hair and prominent Adams apples, experience erections and become taller than most other women. What may intensify their stress is knowing, through information that is freely available via the Internet to which most have access, that: This unwanted pubertal development is medically avoidable. Gender variant young people are denied such treatment in the United Kingdom. Suitable treatment is available in highly reputable centres overseas1 . The feelings of those who do not receive such treatment is illustrated by the following extract from a poem written by a young transsexual man:
1 A comparison between treatment in the UK and overseas is provided in the NHS booklet Gender variance in children and young peopleAnswering families questions[3].
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Gender variance in children and adolescents Why do I fear my own reection? Deformed, disgured, mutilated. I am over-developed and mutated. Young transsexual people have to overcome many obstacles in obtaining medical help to deal with their difculties. The rst obstacle is learning to how to describe their feelings with a childs limited vocabulary. Then, expressing their feelings within their families often seems impossible. What they see is a family, and the world beyond it, neatly divided into two gender expressions: boys and girls, in strict accordance with genital appearance and with no tolerance for any variation from that norm. As explained more fully in chapter 7, society is not tolerant of gender variance. Boys who behave in feminine ways are labelled sissies. Girls showing tomboy traits experience more tolerance but not complete acceptance. Usually, other family members discourage gender variance, often strongly. Expressing gender variance at school frequently leads to bullying. Yet, despite the pressure to conform, some children feel such acute discomfort with the gender roles assigned to them that they try to express their core gender identities in their behaviour and dress. A young boy may, for instance, prefer the owery boots on the left, and may enjoy wearing his sisters or even his mothers clothes. A girl may like the more masculine combat boots on the right. These choices that transgress societys norms can make adults feel uncomfortable; they may forbid it, especially where these gender atypical choices are made by boys. Some families are referred to the specialised gender identity development service (GIDS) for children and adolescents, which is currently part of the Tavistock and Portman NHS Foundation Trust in London. This is the only British specialist centre for treating gender variant youngsters who are, consequently, referred from all over the United Kingdom. Among them, the GIDS found increasing problems with family relationships, avoidance of school and peers, increased depression and hence suicide risk[4]. Ten years ago, the GIDS was receiving about 15 cases per annum. That number has grown to 60 in more recent years. The reasons for that increase are not known. It is possible that there is a real increase in atypi-
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Gender variance in children and adolescents cal gender identity development among children generally. Some fear that might be due to environmental pollution, which does appear to affect the sex characteristics of other species, although whether it affects gender has not been determined. It may just be that, in todays more enlightened society, these children and their families now feel more able to be open about the condition. Certainly, there is greater awareness of gender variance and less stigma attached to it, as a result of its being discussed in television programmes and press articles. Also, the enactment of legislation that protects adult transsexual people, as well as the provision for them of medical treatment within the NHS (albeit this may be less than satisfactory) provides real evidence of societys greater tolerance towards them. Schools need to be aware that the number of young people who seek medical care for gender variance is currently quite small. The 60 new cases referred annually to the GIDS should be compared to the nearly 1,200 adult cases referred for treatment. Almost invariably, adult trans people report having experienced gender variance from early childhood but have not had access to medical care for the condition until adulthood. The GIDS appears to be seeing a very small proportion of those who are affected by gender variance that is likely to persist into adulthood. Schools also need to know that the adult outcome in pre-pubertal gender variant children is uncertain. In children it is sometimes difcult to distinguish potentially atypical sexual orientation from atypical gender identity development. The GIDS found that, in the relatively small number of prepubertal cases it did see, 80% did not progress to become transsexual people i.e. those who undergo transition to live full-time in the gender role that accords with the core gender identity. Many eventually became gay or lesbian people; a few developed as heterosexual adults. Schools should also be aware that, in the absence of long-term followup, it is unknown whether some of the people in whom the gender variance appears not to persist do continue experiencing discomfort but are able to conceal it or deal with it by occasional cross dressing, as transgender, rather than transsexual people. It is also unknown to what extent some of this group are referred later to the gender identity clinics for adults. Nonetheless, in a small number of children the distinction can often be made, and will become more apparent as pubertal changes begin and the transsexual adolescent expresses disgust with the developing secondary sex characteristics. No such revulsion will occur in those who are destined to be gay or lesbian. Within the 20% of the GIDSs users who continued to experience severe gender discomfort in adolescence, the great majority
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Gender variance in children and adolescents (20 out of 23 cases) did go on to experience transsexualism in adulthood. This means that a differential diagnosis, made in early puberty, is likely to be accurate. That has important implications for the way that young people experiencing persistent gender discomfort should be treated. In conclusion, gender variant behaviour in pre-pubertal children is usually not the precursor to a permanent change of gender role. There are varied outcomes. However, all nd the experience stressful. For some the need to express gender variance in behaviour and appearance is very powerful and requires a exible and supportive response, tailored to the individuals needs.
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5
Typical transphobic responses to gender variance
The discovery of gender variance in any pupil, teacher or staff member is likely to be a seismic event for the school where this occurs. Given the rarity of the condition and the frequency with which it remains hidden, there is unlikely to be any previous experience of dealing with such an event within the school. Without rm action by the school, rumours, prejudice and bullying are likely to ensue swiftly. Transphobic bullying results in emotional and even physical injuries. It is not identical to homophobic bullying, although both types of bullying have similar characteristics. Moreover, there are many similarities in the way that both types of bullying should be tackled. Guidance on tackling homophobic bullying is available via Teachernet[5]. Gender variant behaviour, in the pre-pubertal stage and later, provokes verbal abuse that uses specic vocabulary and physical abuse that may be sexual. The actual case examples included at the end of this guidance illustrate the bullying that transgender pupils experience. The 2007 report Engendered Penalties[6] contains data on transphobic bullying based on a survey of 872 trans people. Pages 6267 deal with experiences at school and show that: Half of the natal males and two-thirds of the natal females experienced bullying. Physical abuse and even unwanted sexual behaviours occurred in a majority of these cases. About a quarter of the people who participated in the survey had
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Typical transphobic responses to gender variance been bullied by teachers. Even teachers who wish to be helpful may, in their benign and instinctive wish to protect a child, implement a policy of enforced conformity that is inherently damaging. In an attempt to do whats best for gender variant children and young people, adults may put pressure on them to develop a gender identity that is consistent with the appearance of the body. This may have the effect of completely undermining the young persons feelings of self worth; it may even encourage feelings of guilt and self-loathing. An adult describing such feelings retrospectively talked of patterns of worthlessness and shame. . . and a chronic need to apologise for oneself[20]. Such efforts at coercion, no matter how gently they are implemented, are unhelpful and ineffective. Socialisation cannot overcome gender variant feelings; behaviour may be modied but any appearance of conformity may hide an increased sense of dissonance between the gender identity and the gender role. In an as yet unpublished report, Gendered Intelligence cites the following comments made by young trans people aged from 14 to 21 years of age during a focus group discussion: . . . the gender policing you get with primary age kids. . . I started getting picked on for not being boy enough, not liking football and thinking that ghts are fun and stuff, and like, actually wanting to do my work. And so, yeah, just sort of that, just simply not tting exactly to a stereotype. Peer group would kind of ostracise you and laugh at you and get attacked and stuff. . . . there were some people, only about three lads, who would deliberately call me by my old name. . . And they used to ask me really horrible questions like how big my dick was, and there was nothing I could say back to that. Ive had stuff like, the usual sort of comments, tranny, shemale etc. And you know like people pointing and laughing.
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Typical transphobic responses to gender variance Ive had a teacher, well it was a couple of weeks ago, threaten to suspend me when I cut my hair like this. . . What pissed me off is were a mixed college and theres boys in my class with shorter hair then me. I always got bullied for being in the wrong toilets, and theyd always say the boys toilets are next door or down the corridor or whatever it was. And Id be totally bafed by that point, going erm, what? And then Id get bashed around for being like just questioning. . . the gender norms and roles as a little girl. I sort of got into trouble cause I used to lash out at people being bastards. An I was the one who always get into trouble for it. . . if I threw the rst punch. . . it was usually me. I got sent to anger management classes aged six. . . . you get locked in the toilets and get the shit kicked out of you cause you reported the bullying. . . . theres being stalked by this guy on the Internet. Transgender teachers and other staff members experience verbal abuse that may drive them out of the profession.
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6
Support and protection for pupils dealing with transgender issues Teachers conversation with a trans girl
I am a teacher: what do I say to a schoolchild who discloses to me that he (or she) believes that he (or she) is trans? Much depends on the age of the child. As explained elsewhere, a prepubertal child may not become a trans adult, whereas a young person whose body is changing at the beginning of puberty and who is feeling great distress, is much more likely to wish to transition and that causes wider ramications in the school context that are dealt with below. As explained earlier some very young childreneven pre-schoolchange their gender role. However, on the rst occasion, that a young person, of any age, brings the matter up, you should listen, reassure, offer support and be a friend. If it feels right to ask a few questions, you can do that, but do it gently and dont make it sound like an interrogation; allow the situation to evolve at the pace that the young person is comfortable with. Try not to act as though you are amazed or shocked. Be relaxed and matter-of-fact. In this example, the young person has lived as a boy, but knows herself to be a girl inside. Offer reassurance. It is very brave of you to come and talk to me, and I am really pleased that you felt able to do that
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Support and protection for pupils dealing with transgender issues Now that you have, I want you to know that you can always talk to me Make it clear that you will respect the privacy of the young person: I promise that I wont tell anyone unless you tell me that I can. Allow the young person to express the pain and isolation she must be feeling: Its not easy to live with a secret. You must have been very unhappy and, perhaps, lonely for quite a long time. Reassure her that shes not the only one: You know, although its unusual, there are other young people who feel the same way as you do, so we can make contact with them. You are not alone. You need to know if the young person has any other support: a parent, sibling or friend: Have you told anyone else about your feelings? (if yes) How did that go was your Mum (or whoever) okay with it? (if no) Would you like to tell your family? Do you friends know? Are you scared to tell your family/school friends etc? Offer to support the young person if she wants to tell others: I would be happy to support you when you do tell themif you want me to. Or I could tell them for you, and we can work out together what you want me to say Allow the young person to express her hopes and fears: Do you want to change the way you are living your life? How would you like things to be different? If the young person reveals having considered suicide you will obviously need to explore this very sensitively and share the responsibility with those professionals who are skilled in dealing with this issue, despite what you have promised about privacy. I wont pass on anything you have told me unless I have to in order to make sure you are safe. I will tell you if I need to do this, I will tell you who I am going to speak to and what information I am going to share with them
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Support and protection for pupils dealing with transgender issues Before your rst encounter with the young person ends, you should ask: Are any of the other schoolchildren being nasty to you because they think youre different? Are you being bullied or frightened on the way home? And indicate that: Its okay to be different. Youre just an extra special person. We can work through this together. Youre not alone. Dont push for too much information on the rst occasion unless the young person wants to ofoad all the bottled up feelings. Sometimes, its like a dam bursting and all the anguish spills out in one go. Offer to make a date to talk again.
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Support and protection for pupils dealing with transgender issues highly recommended that transition is arranged to take place in a long vacation. The Dutch clinicians, who have extensive experience of caring for gender variant children, advise against changing role too early because it is an irreversible step that often exposes the child to discrimination and bullying. Nonetheless, the gender variance in some children is so severe that they insist on changing gender role at a very young age. Prepare a contingency plan detailing how the school will respond if a pupil declares an intention to undergo transition to a new gender role or is outed by someone else. The plan should include the following steps: If the school has not already nominated someone to support any child who expresses gender variance, it should do so as soon as a case comes to its notice. Consult with the child and, only if agreed, the parents1 . Consider, if the child and the parents agree, calling on support from: * * * * Gendered Intelligence. Mermaids. Gender Identity Research and Education Society (GIRES) Gender Identity Development Service at the Tavistock and Portman NHS Foundation Trust2 .
If the child is suffering severe stress at being forced to remain in the gender assigned at birth and determined to change gender role, but only if the parents agree with this, set the date for the change, including clothes, and then inform all other staff members in strictest condence, perhaps by means of a letter (see Appendix D for an example letter), to be followed up by discussion at the next staff meeting3 . In consultation with the childs form teacher speak to the immediate peer group and then the rest of the class. The material
Note: the parents may not accept or even know of their childs gender variance. Note: if the child is approaching or past the onset of puberty, that this Clinic does not offer medication to suspend pubertal development. 3 Note: It would only be feasible to allow the change within a mixed gender school; otherwise a change of school would be necessary.
2 1
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Support and protection for pupils dealing with transgender issues that GIRES has produced for use with teenagers may be useful. Contact GIRES regarding information for younger children: admin@gires.org.uk. change the childs name in the school records provided the parents agree. Note: A childs name can easily be changed by Deed Poll providing everyone with parental responsibility for the child consents to the name change. If a child is 16 years or over, they must apply for their own Deed Poll for which parental consent is not needed. provide safe toilet arrangements for the child, for instance use of the staff facilities. inform any other parents who might object to the gender variant childs attendance at the school that the condition is the result of a natural variation in human development and that the child, like every other, has a right to remain at the school and to be kept safe and happy. They may nd it helpful to read the booklets published by the Department of Health[13] It is open for any parents who are unable nally to accept this policy to withdraw their own children from the school. Deal promptly and publicly with any incident of transphobic bullying. This should include bullying by other pupils within the school and beyond its gates. Record all such incidents, without divulging the victims identity. If there is a criminal element in any incident, such as violence, sexual assault, theft or Internet/text message harassment, report it to the police, but only if the victim agrees. The youngster may not wish to be outed. Members of the family may not know of a young persons gender variance. Each police service will have a hate crime coordinator and often also an ofcer with specic responsibility for transgender as well as lesbian, gay and bisexual issues. As one trans youngster reported after experiencing cyber bullying: The policeman arrested him and basically got him to confess, and if he hadnt confessed he would have gone to court and got in a lot of trouble. And he got off with a warning just cause he confessed and said he wouldnt do it again. [Reported from a Gendered Intelligence focus group].
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Support and protection for pupils dealing with transgender issues If there is a criminal element in any incident, such as violence or unwanted sexual behaviours, publicise Childlines advice to victims of bullying and make it clear that this applies equally to transgender pupils: * Dont ignore itit wont go away, and it may get worse. * Tell someone you trusta teacher, parent or friend. * Rememberits not your fault. No one deserves to be bullied. * Keep a recordand save any nasty texts or emails. * Try to stay away from the bullies or stay in a group if you dont feel safe. * Ask your mates to look out for you. * Try not to retaliate. * Check your schools anti-bullying policy. It applies to trans people too. * Try to act more condenteven if you dont feel it. * Call a helpline Mermaids 07020 935066 : Monday to Saturday, 37pm only) Find ways to include transgenderism in the curriculum: * In personal, social and health education (PSHE) classes. Teaching material prepared by GIRES may be useful. * In the teaching of biology, in respect of the sex differentiation of the brain involved in the formation of gender identity, refer to the papers: Transgender ExperiencesInformation and support[14], gender variance: SchoolsYears 10 and 11[21]. For teachers:Atypical Gender DevelopmentA Review[2], Denition and Synopsis of the Etiology of Adult Transsexualism[22]. * Generally within other subjects, for instance via gender expression in art or via statistics related to the transgender population in maths. For younger children helpful reading material such as The Sissy Duckling by Harvey Fierstein and Oliver Button is a Sissy by Tomie de Paola. Two general equality and diversity books for children (both by Todd Part) are also really good ways to discuss diversity with young children and help reduce school bullying. Other suggestions are Its Okay to be Different and also The Family Book.
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7
Medical care for gender variant young people
Schools need to be aware that the medical treatment provided, or not provided, to young people experiencing gender variance can have a dramatic effect, either positive or negative, on their behaviour and performance at school. They will not always need to know the detail of the treatments but the following information may be helpful. When families seek medical help to deal with the gender variant behaviour of a child, the professionals may respond unhelpfully. They may predict that the child will grow out of it and that, meanwhile, rewarding gender congruent behaviour and punishing gender variant behaviour can achieve conformity. One mother felt that the NHS clinicians responsible for her trans daughters care failed spectacularly. Although her daughter desperately needed hormone support to enable her to get through her A level years, the clinicians simply ignored her plea. She was depressed and suicidal and missed much of her schooling. When she was prescribed hormone medication by a private clinician, at age 17, the difference in her mental and emotional state was startling and wonderful, but it was too late to catch up. Medical treatment is provided in a series of phases that include: Careful psychological assessment and counselling. Fully reversible intervention: medication to block the production of the natural hormones that feminise or masculinise the body during puberty. Partially reversible intervention: prescribing hormones to masculinise
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Medical care for gender variant young people or feminise the body in accordance with the core gender identity, allied with control of height. Irreversible intervention: surgery to alter the body to conform as nearly as possible to the core gender identity, which is not carried out before the age of 18. The rst stage of treatment, psychological assessment, may start well before puberty. It will include helping the family to live with the uncertainty about the nal outcome. Families should be supported in maintaining a respectful acceptance of gender variant expression. It is also important for the school to be involved. Teachers need to be educated; they and the parents need to be very alert to the relationship problems these young people frequently experience with their peers. This can include bullying. Strategies to protect the child must be put in place, including work with peer groups and other pupils. This may include inviting young trans people from elsewhere to talk with other staff and pupils 1 . In making the decision to proceed to the second phase, fully reversible intervention, clinicians must rely on the young persons own account of his or her feelings, the obvious behaviour and presentation of the young person, information from the parents (and sometimes teachers) and psychological tests. There is persuasive evidence that the brains of transsexual people are programmed before birth to develop, in small but highly signicant ways, inconsistently with the rest of the body. However, this difference is, and is likely to remain, undetectable in living subjects. No physical test is available. Nonetheless, some clinical teams are condently diagnosing transsexualism in young people in the early stages of puberty. In The Netherlands, and in major treatment centres in Australia, Belgium, Canada, Germany, Norway and the USA, which collectively have experience of dealing with hundreds of cases, clinicians have developed extensive expertise in psychological assessment leading to a diagnosis of transsexualism. They, therefore, feel condent enough to provide hormone blockers just after the start of puberty in carefully selected cases, but only at the express wish and with the fully informed consent of the adolescent and the parents or guardians. An explanation of the basis upon which consent may be lawfully obtained in the United Kingdom is contained in Appendix A. In Australia, the actual consent of the Court is also required (although this is currently being challenged through legal action).
For instance Gendered Intelligence, which is amongst the Helpful Organisations listed at the end of this document, has helped schools in this way.
1
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Medical care for gender variant young people By this early stage of puberty, before the young person has developed unwanted secondary sex characteristics, he or she has, nonetheless, been able to experience the initial effects of naturally produced hormones. The young persons reaction to the inux of these hormones (their physical and physiological effects) in an important factor in determining whether or not the condition is likely to persist. Suspending puberty provides the adolescent, and the clinicians, with an extended period of time in which to examine thoroughly the young persons sense of gender identity whilst being spared the stress of full puberty. Improved psychological and social function is reported in young people helped in this way[10]. During this process, the adolescents bone density, ratio of leg length to body length and overall height are carefully monitored and controlled. Adolescents and their parents or guardians should be carefully advised on the implications for fertility. In the case of adolescents contemplating transition from living as a boy to living as a girl, suspension of puberty at an early stage prevents the production of sperm, which might otherwise be stored and thus enable them to have children of their own. However, spermatogenesis will be re-established if they choose to stop hormone blockers for a short period in order to regain reproductive capacity. Another matter to consider is that the underdevelopment of their genitals provides less material for later use in the surgical construction of a vagina, although there are techniques for dealing with this problem. Potential fertility is not lost in the case of young trans boys. Following a substantial periodup to two or three years of reversible interventionadolescents who are conrmed as transsexual, may then be prescribed cross-sex hormones (testosterone for a trans boy; oestrogens for a trans girl). This third phase of treatment produces changes which are only partially reversible, and is not usually undertaken before the age of 16. Surgery can be offered later, generally not before 18, to align the body as closely as possible to the conrmed gender identity. Suspending pubertal development and then administering cross sex hormones enables these young people to develop in accordance with their innate gender identities. It spares them from painful and costly medical treatment in adulthood to correct inappropriate development, e.g. chest reconstruction for trans men and facial hair removal for trans women. The above hormone blocking treatment, introduced in early puberty, accords with the guidance and standards of care published in 1998 by the United Kindoms Royal College of Psychiatrists (which stipulates that offering hormone blocking medication should be based on a second psychiatric opinion) and Standards of Care published in 2001 by the Harry Benjamin
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Medical care for gender variant young people International Gender Dysphoria Association (now renamed as the World Professional Association for Transgendered HealthWPATH), the recognised world authority in this eld. Both of these documents were prepared by large, experienced, multidisciplinary and international teams. If the adolescent did revert to the gender role assigned at birth, the hormone blockers would be discontinued and the previous pubertal pathway would be resumed automatically. So far, none of the Dutch adolescents treated in the above way has chosen to revert and none has expressed any regret. In the United Kingdom, the principal clinicians responsible for prescribing blockers for such adolescents delay this treatment until all the pubertal body changes are complete. They feel that to interrupt or interfere with the normal pubertal process may result in unsatisfactory physical development and signicant psychopathology. They state the adolescents have to accept changes that they consider foreign. There is a continuing debate about the differences between the Dutch and British approaches. Meanwhile, schools need to be aware that pubertal changes are causing intense stress and even suicidal feelings in young transsexual people and then require signicantly more invasive and costly surgical and other corrective procedures than is the case if puberty is suspended in the early stages. The following extracts are from a letter written by a 16 year old British individual, who has commenced the transition from living as a young man to living as a young woman. She has been denied hormone blocking medication. Her letter was addressed to the female paediatric endocrinologist who was responsible for her care. The last two and a half years have been horrendous for me, with my body becoming so disgustingly adult male that I cannot bear it. Imagine how you would feel if, tomorrow morning, you were to wake up to nd yourself in a male body, with a mans voice and a mans face looking back at you from the mirror, with early morning beard and moustache stubble, with no breasts, an Adams apple, large male feet and hands, a body covered in thick, black hair and a penis and testicles. Would your brain be screaming out, in protest, that you are female, not male? Living in a male body hurts beyond belief. I sometimes feel as if I will go crazy with the sadness and desperateness of it. My body will never, ever be as I would like it to be and now,
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Medical care for gender variant young people unfortunately, it is really a case of damage limitation. The Dutch clinicians are not permitted to treat children from other countries. Currently, British families who wish their adolescent children to be psychologically assessed and, if appropriate, offered early suspension of puberty, are obtaining medical help in the USA. Clearly this is a very expensive option. A description of such a case is available on the GIRES website. Schools may wish to know of a booklet that GIRES has prepared for the Department of Health Gender variance in children and young people: Answering families questions[3] which is available in printed form and online.
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8
Children of transgender parents
School staff may nd it helpful to know of research, which shows that: transsexual parents can remain effective parents and that children understand and empathise with their transsexual parent. . . gender identity confusion does not occur (as a result of the relationship with a transsexual parent)[7]. Children of transsexual parents are not themselves likely to develop features of gender dysphoria, nor do they experience mental health problems associated with gender identity disorder[8]. Similarly, the long term evidence of children raised by same-sex couples demonstrates that quality of parenting is far more signicant for childrens psychological well-being than whether they are being raised in one type of family or another[9]. The following case example illustrates the problems that transphobia causes in school for the children of transgender parents. Stephanie (not real name) was constantly bullied in her village school because both of her parents were trans people: a trans man, her birth mother, and a trans woman, who had been the only mum she had known since the age of four. To avoid the bullying, her parents had to move her to a boarding school far away, where nobody was told of their transsexual history. Even if the children of transgender parents are not being bullied on that account, they may be stressed by experiencing the effect that transgenderism is having within their families, as in the following case.
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Children of transgender parents The schoolwork of two brothers was adversely affected when their father commenced transition and was forced by their mother to leave the family home. The fathers relationship with his sons was then broken off when their mother refused further contact. Eventually, the Family Court permitted supervised contact. The father was required to dress in male clothing. However, that was in breach of the condition that he live full-time in the female role, which was imposed by the Gender Identity Clinic when it sanctioned his commencing hormone medication. The mother frequently failed to ensure that her sons turn up for their scheduled appointments with their father. A parent reported: Identifying as a trans woman, my own children have been subjected to transphobic bullying at school. One particular boy used to keep teasing and provoking my second eldest son so much about my trans status that eventually he retaliated and thumped him. Hence he was excluded from school for two weeks. When challenged the school denied it had a problem with transphobic behaviour. . . . the problem eventually escalated so much that all my children became targets, being spat at, stones thrown at them, bullied etc. However, there are positive stories. One trans woman reports that after her primary school child told her teacher about her parents change of gender role the response was Whats her favourite colour?.
A young woman with her parents both of whom have transitioned. Her birth mother is on the left.
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9
Medical treatment options for gender variant adults
The small number of people who experince extreme gender variance may nd that they have no alternative but to transition full time to the opposite gender role, and have medication and surgery to overcome their severe discomfort. They will usually undergo the following process: Assessment to conrm that the experience of the profound gender variance (gender dysphoria) is likely to persist unless treated. In some cases, counselling to help them deal with the stress that often accompanies gender dysphoria. Hormone medication, to feminise or masculinise the body. Living full-time in the new gender role, (sometimes referred to as the real life experience) in the home, socially and at work; this is a mandatory precursor to genital surgery. Hair removal for trans women. Speech therapy, for trans women and trans men. Surgery see tables 9.1 and 9.2 for possible procedures.
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orchidectomy penectomy vaginoplasty clitoroplasty labioplasty mammoplasty thyroid chondroplasty facial feminising body reshaping crico-thyroid approximation hair removal hair transplant
removal of testicles. removal of penis. creation of vagina. creation of clitoris. creation of labia. breast enlargement. reduction of Adams apple especially reshaping nose and chin raising the pitch of the voice. donor site as well as facial and body to mitigate male pattern baldness
mastectomy hysterectomy salpingo-oophorectomy vaginectomy metoidioplasty phalloplasty urethroplasty scrotoplasty testicular prostheses penile prosthesis hair removal
chest reconstruction removal of uterus removal of fallopian tubes and ovaries removal of vagina creation of micro-penis, using the clitoris creation of penis, with or without urethra. creation of urethra within the penis creation of scrotum. implantmaking erection possible donor site
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Medical treatment options for gender variant adults The specic procedures that are appropriate vary from one individual to another. However, for most trans people, at least some of the listed surgery is essential. Waiting times for treatment within the NHS may be signicant and funding policies vary from one PCT to another. Some treatments may have to be self funded. More information about NHS funding processes and waiting times is available from the GIRES website.
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10
Non-medical issues involved in a permanent change of gender role
In addition to obtaining and nancing medical treatment, adult trans people who undertake transition have to undertake the many other tasks. Hence, schools can expect a transitioning member of staff to need support in handling a host of new experiences and challenges. Any support worker should be aware that this may include: Carefully informing all who need to know. Handling relationships. Maintaining access to own children1 Using gender-segregated facilities. Declaration, Statutory Declaration or Deed Poll of new identity to use in obtaining new documents. Sustaining employment. Conrming pension provisions. Maintaining any entitlement to state benets. Continuing social activities safely. Coping with transphobic crime.
Guidance on the Court process for transgender parents who are seeking access to their children is available on the GIRES Website.
1
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Non-medical issues involved in a permanent change of gender role Obtaining support during the periods of crisis that often occur. Dealing with media intrusion. Obtaining legal support to deal with extreme problems. Altering appearance by non-surgical means to conform to the new gender role. Clothing, footwear and wigs. Cosmetics. There are also many documents to be corrected.
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11
Legal and policy safeguards for transgender people General
Schools have a legal obligation to tackle all forms of bullying including that of trans pupils and staff. Current protection for school pupils lies in education, common and human rights law, rather than discrimination law. The main protections are in the following legislation:
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Legal and policy safeguards for transgender people and promote the rights and welfare of children. Education Act 2002 Section 175 imposes duties on Education Authorities and governing bodies in relation to the welfare of children. Each must ensure that their functions are exercised with a view to safeguarding and promoting the welfare of children, and in doing so, must have regard to any guidance issued by the Secretary of State. School Standards and Framework Act 1998 Section 61 imposes a duty on governing bodies to ensure that policies designed to promote good behaviour and discipline on the part of its pupils are pursued at the school and to make and keep under review a written statement of general principles to which the headteacher must have regard in determining any measures to encourage good behaviour and respect for others on the part of pupils and, in particular, preventing all forms of bullying among pupils and, in exercising these functions, to have regard to any guidance issued by the Secretary of State. Common law duty of care, interpreted in case law See in particular the Hillingdon case ([2001] 2 AC 619), in which the House of Lords (comprising 7 Law Lords) held that all teachers owe a duty of care to all their pupils in relation to the way in which they discharge their teaching responsibilities. In making that decision, the Law Lords considered but were not persuaded by a full range of arguments about oods of unmeritorious or malicious claims; the burdens on schools of defending these, or indeed any claims, through the courts; the need for schools to keep records in order to be able to satisfy their obligations and the burdens of that, tooand the effect on the overall standard of education that might then be on offer. Human Rights Act 1998 Schools, Education Authorities and the Department for Children Schools and Families (DCSF), like all other public bodies, are subject to the Act. The HRA includes the rights and freedoms of the European Convention on Human Rights (ECHR). This includes protection against discrimination connected to transsexualism. However, such rights have to be balanced against those of the wider community. The Department for Constitutional Affairs published a useful guide to the legislation in 2006: Making sense of human rightsA short introduction.
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Legal and policy safeguards for transgender people The Schools Inspection Act 1996 By this Act, school inspectors have a duty to report on the quality of education and the spiritual, moral, social and cultural development of pupils. The inspectors are thereby enabled to include information about transphobic bullying in their reports. A number of policy documents provide further protection: Every Child Matters 2003 This guidance requires schools to support students in being healthy and safe, while enjoying their education, making a positive contribution and achieving economic well-being, regardless of their background or circumstances. National Healthy School Programme 2005 Achieving Healthy School status depends on meeting criteria that include pupils emotional health and wellbeing. Schools are advised to identify vulnerable groups and establish strategies to support them. The responsible minister stated at the Schools Out Conference in London, on 2 February 2008, that any school that permitted transphobic or homophobic bullying would not be eligible for Healthy School status (More information about the programme can be viewed here). Social and Emotional Aspects of Learning 2005: This guidance covers both primary and secondary schools and includes a Say no to bullying section. The above legislation and guidance does not specically refer to transgender pupils or transphobic bullying. Nonetheless, the Department for Children Schools and Families (DCSF) is not prepared to tolerate the bullying of a child or young person for any reason. The DCSF believes that the above legal safeguards are sufcient and more exible in these sensitive situations than any discrimination law provision could be, enabling schools, pupils and parents to work out case-by-case solutions, with the pupils best interest fully in mind. Under these provisions, because the principles to be acted upon are so clearly set out, targeted measures can be taken to tackle the problems which might be encountered in the case of transgender issuesbullying, uniform, changing and toilet facilities, participation in school sports, going on school trips, after school activities, dealing with parents or single-sex schools. The education law, policy and guidance governing whichever of these areas of impact is engaged in any
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Legal and policy safeguards for transgender people particular case would be taken into account. These measures allow careful and low-key responses that do not result in still greater disruption to the childs education. Uniform may be an issue where a pupil wishes to change gender role and clothing. Schools are responsible for determining their own uniform policies. Where a gender variant pupil wishes to attend school dressed in accordance with the innate gender identity, rather than that assigned at birth, the matter has to be resolved between the school and the family concerned. The guidance provided by the DCSF via Teachernet advises that a school: . . . considers carefully, once the uniform/appearance policy has been agreed, any request that is made to vary the policy to meet the needs of an individual pupil because of temporary or permanent medical conditions. Schools may expect parents who support their childs transition to argue that profound and persistent gender dysphoria is indeed a permanent medical condition. Moreover, any school that was minded to exclude a gender variant pupil on the grounds of failing to adhere to its uniform code should consider carefully the DCSF guidance published via Teachernet: Exclusion should not be used for breaches of school uniform rules except where these are persistent and in open deance of such rules. Schools need to be aware that, if the pupil is permanently excluded then the parents can appeal against the decision and this will be reviewed by the school governors and by an independent panel if necessary. Schools may therefore conclude that, except in a single-sex setting, a pupils wish to change gender role and clothing should be accommodated.
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Legal and policy safeguards for transgender people Max Benton (not real name), aged 65, is a trans man who was surrounded by a group of young people from the local school when walking home through the public park. They poked him with sticks and shouted transphobic abuse. He described his experience as being like being in a medieval painting of tormenting demons in hell. Greg Barnes (not real name), is a young trans man, who described being harassed via the Internet: Theres someone leaving anonymous posts on my journal . . . its obviously someone who knows me . . . they want to be anonymous . . . to be randomly abusive. The DCSF has published specic guidance on how schools should deal with the second type of case, which involves cyber bullying.
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Legal and policy safeguards for transgender people disposal and management of premises in the Sex Discrimination (Amendment to Legislation) Regulations. This means that transsexual people must not be treated less favourably than others when such services are being provided or accomodation is being considered. However, this does not cover education. A more detailed explanation of the legislation that protects transsexual people employed by schools is given below.
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Legal and policy safeguards for transgender people must consider whether these tasks could not be carried out by someone else. Another example is where individuals have to share accommodation and it is not reasonable on privacy or decency grounds to do so while in the process of undergoing gender conrmation treatment . In this case the school would have to show that it would not be reasonable to provide alternative accommodation for the individual. Once an individual has acquired a new legal gender status by virtue of having a Gender Recognition Certicate, then that person must be regarded as having that status for the purposes of establishing a genuine occupational requirement. For instance, someone who was assigned as a boy at birth, but who has subsequently acquired the legal gender status of a woman, must be regarded as a women. The same person, living full-time as a woman but without a Gender Recognition Certicate may be regarded as having the gender status of a man, for the purposes of a GOQ and, therefore may not be deemed an appropriate person to undertake certain work. However, this limitation will not always be necessary or appropriate, and common-sense should prevail.
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Legal and policy safeguards for transgender people must convince it of their intention to live in the new role for the rest of their lives. This is a paper exercise and does not require the applicant to appear in person. Details of medical treatment and relevant dates are required. Genital surgery is not a requirement, although where it has taken place, applicants must supply details. The distinctions between those who qualify for GRCs and those who do not, are not necessarily medical. Trans individuals who are legally married, and do not wish to dissolve that marriage, are not permitted to have a GRC. An Interim GRC of 6 months duration may be obtained, but it confers no legal rights and serves only as a way of dissolving the marriage, whereupon it is converted immediately to a full GRC.
Lin and Emma were married. Emma transitioned and obtained a Gender Recognition Certicate giving her full legal rights. She and her partner are now in a Civil Partnership.
One of these women has a transsexual history. She and her wife chose to remain married; this prevents her from obtaining a Gender Recognition Certicate
The GRC gives trans people the right to marry someone of the opposite sex, and to have a civil partnership with someone of the same sex (Civil Partnership Act, 2004). The possible combinations can be seen in the chart. Adult transsexual people are entitled to a wide range of legal protection, whether or not they have a Gender Recognition Certicate. Note it is incorrect to demand production of such document before, for instance, entering a new name into records. It is good practice to treat all trans people
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Legal and policy safeguards for transgender people as if they did have a Gender Recognition Certicate.
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Legal and policy safeguards for transgender people Privacy versus Disclosure under the GRA: There is no requirement whatsoever for job applicants and interviewees to disclose their transgender status unless they wish to. If they choose to disclose, this cannot be a reason for not offering employment, and non-disclosure or subsequent disclosure is not a ground for dismissal. If a person working in an ofcial capacity becomes aware that someone has a Gender Recognition Certicate (and therefore a transsexual history) it is a criminal offence under the Gender Recognition Act to disclose that information. It is also good practice to extend the same protection of privacy to those transsexual people who do not have a Gender Recognition Certicate. If a manager is giving a reference for an existing trans staff member, the manager must use the name that is used by that employee and not refer to a former name or gender status. Unwarranted breaches of condentiality should be treated in a serious manner and may amount to harassment Disclosure Access to records and any other details associated with the individuals trans status should be restricted to appropriate school staff who need to know for specic reasons. Need to know refers to those staff directly involved in the administration of a process, for example, human resources, occupational health or pensions.
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Legal and policy safeguards for transgender people To consult stakeholders and take account of relevant information in order to determine its gender (including transgender) equality objectives. To assess the impact of current and proposed policies and practises on gender (including transgender) equality. To implement the actions set out in the scheme within three years, unless it is unreasonable or impracticable to do so. To report against the scheme every year and review the scheme at least every three years. Schools will need to consider having an equality scheme objective relating to transsexual employees to comply with the specic duties. When consulting with stakeholders, the Equal Opportunities Commission (now part of the Equality and Human Rights Commission) recommends that public authorities (including schools) specically target trans advocacy groups to ensure that the needs of the trans community are taken into account when developing policy and gender objectives. Public authorities will need to assess the impact of their policies and practises on trans people in order to determine whether they have a discriminatory effect they may not realise that their policies may be indirectly discriminating unless they conduct an impact assessment.
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Legal and policy safeguards for transgender people The Equality and Human Rights Commission recommends, as good practice, that schools, as well as other public authorities, apply any provisions for transsexual people to those who dene as transgender as well, see Meeting the gender duty for transsexual staffGuidance for GB public authorities which is available online[11]. There may be reasonable and practical limits to the extent to which schools can meet this advice. For instance, transgender people who are not intending to undergo gender conrmation may only be allowed to use the toilet facilities appropriate their birth sex. Good practice would be to let them use the toilet facilities appropriate to their permanent mode of dress.
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12
Support and protection for transgender staff
Schools have clear obligations to support transgender members of staff. This includes not only teaching staff but all ancillary workers. As explained in Chapter 11, on legal and policy safeguards, a transgender adult with a Gender Recognition Certicate should be treated in all respects as being of the recognised gender. A member of staff who is intending to undergo, is undergoing or has undergone medically supervised transition, but does not have a Gender Recognition Certicate, is protected against discrimination. Employers are advised to provide similar safeguards for other transgender people. If a staff member informs the school that he or she intends to undergo transition, the school should provide support. It will need to discuss a series of specic issues relating to the transition, which are likely to include those listed below. Many of these will also apply if a trans person who has previously undergone transition is outed. Futher support may be forthcoming from the relevant Trades Unions. A person who is transitioning should be involved in all discussions about how to deal with issues that arise in the school context. It is likely that important changes in dress and presentation and, possibly, some treatments requiring lengthy recuperation may be undertaken during school holidays. However, the individual may not have absolute control over the timing of medical treatments so any anticipated schedule may need to be changed according to circumstances. Therefore the school should remain as exible as possible. Policies: Whether the individual is adequately covered by existing policy on issues such as condentiality and harassment and if not how these will be amended.
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Support and protection for transgender staff Possible Redeployment: Whether the individual wishes to stay in the current post during or after gender conrmation or, if possible, would prefer to be redeployed. Schools should be aware that one of the effects of feminising hormones in trans women is to reduce upper body strength. This might be applicable to those who maintain the buildings and grounds, for instance. Genuine Occupational Qualication: Where a member of staff is already employed in a position or environment involving a Genuine Occupational Qualication (GOQ) prior to a change of gender role, it is important that the school discusses the issues and options with that individual early on, in order to come to a mutually acceptable arrangement. For instance, in single gender schools, some jobs may only suitable for people of that gender. Discrimination or dismissal on the grounds of a Genuine Occupational Qualication is not permissible where there are other staff available to do a sensitive task and, in any event, dismissal should be a last resort. Risk Assessment: This may include reference, in strictest condence, to a medical professional for advice on tness for work issues and the individuals ability to carry out the full scope of the job. Advice on absence relating to treatment for transgender purposes may also be sought. This will indicate whether there are current duties that should not be undertaken at specic times within the transition process (such as strenuous physical work). For instance, this would ensure that that an individual engaged in maintenance work on the building or grounds is kitted out with clothing, footwear, headgear and equipment appropriate to the new gender role. It is good practice for schools to do a risk assessment based upon discussions with the person who is transitioning. Concerns about problems that may arise can be addressed and action taken later to minimise risk, Steps might include alternative duties allocated on a temporary, or on a permanent, basis if the treatment is likely to affect his or her capacity to do particular work. Post surgery, advice may also be needed regarding any temporary adjustments which may be required to assist an individual to return to work, who may not initially be able to undertake all aspects of their substantive role. If there is a risk of harassment or even violence, the school should
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Support and protection for transgender staff involve the local police Each force should have an LGBT Liaison Ofcer. Timings: Transition from one gender role to another is not an endless process but it does encompass a number of stages, which usually include medical treatment, including surgery. The school will wish to know the expected timescale of the medical and surgical procedures and the time off required for medical treatment. It should give reassurance that this will not adversely affect the employees pay and promotion. It is good practice to discuss as far as possible in advance the time away from work that an individual will need to undergo gender conrmation treatment. Consultations and hospital appointments may require full days away from work in addition to any time required for surgical procedures. Flexibility should be allowed for individuals to undergo treatment. It is important to remember that it may constitute unlawful discrimination if an individual is treated less favourably when undergoing gender conrmation treatment than others who are absent from work for other medical reasons. On the other hand, schools may be cautious about allowing time off that does not accord with their established sickness policies. See the list of Helpful Organisations at the end of this guidance from which schools can obtain further information. Commencement of Transition: Although the individual is entitled to decide the expected point or phase of change of name, personal details and gender role, the school should advise on the practical consequences of the change and suggest an alternative date if that seems advantageous. Disclosure: The school should ascertain whether the individual wishes to inform management, colleagues and associates or would prefer this to be done by someone else who is agreed to be suitable. It is usually good practice for the employer to take responsibility for informing those who need to know, though the known wishes of the individual concerned are of paramount importance in this regard. If the staff member wishes to make the disclosure, the school will need to know when this is to take place and how much information will be disclosed in order to provide appropriate support to the members of staff involved. Many transsexual people wish to keep their transsexual status private, whilst others are willing to discuss it condentially
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Support and protection for transgender staff or openly. There is no need or obligation for an individual to disclose his or her transgender status as a condition of employment nor is there any obligation on the employer to inform colleagues and the public that a member of staff is intending to undergo, is undergoing or has undergone gender conrmation. Unless the individual agrees otherwise, the details should only be shared where the relationship is with someone who knew the trans person prior to his/her change of status and is to continue. At the point of change, it is common for transsexual people to take a short time off work and return in the new name and gender role. This would be arranged in accordance with the schools leave and absence policy. During the trans persons absence, colleagues should be briefed. In all cases, the legal obligations of the school should be explained and the unacceptability of harassment made clear. Training: The school should consider whether training or brieng of colleagues will be necessary and at what point and by whom this will be carried out. Most people in the general population know very little about transgenderism. Disclosure relating to one individual should take place in the context of a wider education of staff and pupils on the subject of gender variance. This should encompass an appropriate level of understanding of gender variance conditions, the law and good practice in relation to any trans staff or pupils, the legal obligations on privacy and equal treatment, and the schools intentions to implement a zero tolerance approach to any incidents of bullying or harassment. However, unless training is provided, an edict about the permissible behaviour of other staff may generate anxiety about saying the wrong thing or even resentment and result in the isolation of the trans person. However, many trans people welcome straightforward questions and discussion. The school may nd it helpful to distribute the booklet, Transgender Experiences[14]. Pupils: The school will need to consider how best to inform pupils about the intended change of gender role, especially if the individual holds a teaching position. Parents of Pupils: Consideration should also be given to whether any announcement to the parents or guardians of pupils is necessary and how this, in the light of the individuals wishes, will be carried out.
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Support and protection for transgender staff Media: Given the sensitivity of gender conrmation, particularly in a school, there is always the possibility of intrusion from the media. There is a need for a prepared media strategy to be in place to respond to inquiries regarding a transsexual employee. In the interests of condentiality, the name and specic post of the individual should not be revealed. If the identity of the individual becomes known to the media, the risk assessment should be reviewed immediately. It may be necessary to protect the individual with additional control measures such as redeployment away from contact with members of the public. If the individual is besieged by the media at home, the school should support a temporary move to a new address. The wishes of the individual must be considered in any response given to the media. External Agencies: There should be discussion about liaison with any external agencies or contractors in respect of any outstanding matters in which the individual is currently involved. Records: It is good practice for employers to update their records to ensure that any references reect the correct name, title and gender at the commencement of transition. In any case, this will become mandatory if the trans member of staff obtains a Gender Recognition Certicate. Security of Information: In some cases it may be necessary to retain records relating to an individuals identity at birth, for example, pension or insurance purposes. Access to any records showing the change of name and other details associated with the individuals transgender status such as records of absence for medical treatment should be secured and restricted to staff who require such information to perform their specic duties. As explained previously, such information is classied as sensitive under the Data Protection Act 1998. The extent to which this information will be released should be determined in consultation with the trans individual concerned. Any subsequent paperwork that indicates the individuals transsexual status should not be accessible to other personnel. CRB Check: The forms used for employment security checks via the CRB may
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Support and protection for transgender staff lead to identication of trans status. The CRB has now devised a process which allows transsexual people to pass details onto the CRB without rst revealing them to the employer but allows the CRB to carry out the requisite checks against any previously held identities. Only where checks have revealed a conviction will the details of any previous names be revealed on the Disclosure. Transsexual candidates wishing to take advantage of this separate procedure should contact the CRB Sensitive Casework Manager. All information received by the school will remain condential and the disclosure of this information will be restricted to those personnel involved in the procedure, who will be required to honour that condentiality. Any subsequent paperwork that indicates the individuals transgender status should not be accessible to other personnel. Gender Recognition Certicate: Where the trans person who has been outed is protected by a Gender Recognition Certicate, it is wise to have a written agreement regarding any disclosure of protected information. Any subsequent disclosure should be discussed with the trans person before it occurs, and the reasons should be carefully explained. Although those without GRCs are not protected in this way, it is good practice to accord them the same degree of privacy. Equal Opportunities Questionnaire: Transsexual people in employment may choose voluntarily to disclose their trans status in answering an equal opportunities questionnaire. Again, strict condentiality should be observed. Insurance: Employers, which may be the Local Education Authorities, registering staff for corporate insurance and benets policies are advised to inform their underwriters if they know of a trans employees status, since some insurers automatically invalidate a policy if a major fact such a gender conrmation is not disclosed. The employer should inform the employee before disclosing the information. If an employer is unaware that an employee has a reassigned gender, the obligation to disclose falls upon the employee, who could also be held liable in the event of an accident for which no valid insurance cover exists. The Education Authority should respect the condentiality of any information that it receives concerning the individuals trans status.
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Support and protection for transgender staff State Pension: Everyone born after April 1955 now receives state pension at 65. But women born before 1950 can claim state pension at 60, and those born between 1950 and 1955 can claim it at a point between 60 and 65. For state pension purposes, transsexual people can only be regarded as the sex recorded at birth until they have obtained a new birth certicate under the provisions of the Gender Recognition Act 2004. Otherwise, those born prior to April 1955 can only claim state pension at the age appropriate to the sex on the original birth certicatethat is for transsexual women at age 65 and for transsexual men at 60. It is the responsibility of the employer to take suitable steps to keep condential the reason for the individuals apparently early or late retirement. Occupational Pension: The employer should, in condence, inform the managers of its occupational pension scheme about the individuals intended transition. Dress: The school should consider the implications of any dress code or uniform requirements. It is good practice to allow enough exibility in the dress code to accommodate the process of transition from one gender role to another. For example, in the transition from living as a man to living as a woman, exibility should be allowed over hair length and style, jewellery and make up. If the individual is working with the public, a temporary redeployment out of the public gaze may be appropriate. Facilities: The use of single sex facilities is always an issue that is regarded as problematic when a trans person undergoes transition. So, there should be agreement on the point at which the individual will commence using single sex facilities in the new gender role , for example toilets and changing areas, and any interim arrangements that may be agreed to be necessary. Those who transitioned at an earlier date, say, before joining the school or perhaps moving from one place of work to another, and who are living full-time in the post-transition role, with or without a Gender Recognition Certicate, should use the facilities appropriate to their present gender status. This is their right if they have a Gender Recognition Certicate, and it is good practice, even if they do not have one.
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Support and protection for transgender staff The point at which a trans person should start using the facilities allocated to the new gender, is when he or she starts living permanently in the post-transition role. If other staff members have been properly informed and educated, as well as warned about discrimination, this should not cause difculties. However, trans people themselves are not always comfortable, in the early stages of their transition, to use facilities that have, so far, been outside their experience. As with all other practical matters, the decisions about the use of facilities in the short term should be discussed and decided jointly. In the case of Croft v. Royal Mail Group PLC 2003, the Court of Appeal held that an employee who was undergoing male to female gender had not been discriminated against on the ground of sex when her employer refused to let her use the female toilet and instead required her to use a gender-neutral disabled toilet as a temporary measure. In the Court of Appeals view it was inherent in a situation involving the use of toilet facilities by employees undergoing gender conrmation that there be a limited period during which an employer is entitled to make separate arrangements for those undergoing the change. However, this is discriminatory, even if practical, and does promote a negative view of the individual. Good practice would be to identify facilities, which are rarely used as an option for an interim period. Some employers have found a way round any potential difculties, by insisting that the trans person may use the appropriate toilet facilities immediately and any other non-trans person who is uncomfortable with that may use the toilet designated for disabled people. The school and the individual should agree the point at which the use of facilities such as changing rooms and toilets should change from one gender to another. An appropriate marker for changing the facilities used by the employee may, for example, be the point at which the individual begins to present permanently in the new gender role. Support: Although it is critical to the wellbeing of a trans member of staff that school undertakes all the above tasks during the transition process, the individual certainly requires sustained support thereafter. This applies equally to any new member of staff who may have transitioned in a previous workplace. Strict condentiality applies to new as well as existing employees. While schools have to accept that the spread of rumours about a trans persons status cannot be pre-
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Support and protection for transgender staff vented, the school can certainly take prompt action against any unacceptable behaviour that this might provoke on the part of other staff members or pupils. Considered and well-documented discussion of the above issues should identify and deal with potential areas of conict before they arise. Nothing should be done without the knowledge and consent of the individual. Individuals to have the right to the assistance and support of a colleague or a union representative during this process. Once the above list of issues has been discussed and agreed, a Memorandum of Understanding outlining the necessary actions to be taken should be drawn up, signed by the transitioning member of staff and the school head or deputy head. It should be reassessed at each signicant stage of the process and reviewed when deemed necessary by either party; it is essential for the employers to remain exible. The Memorandum is a strictly condential document, should be marked as such and subject to controlled distribution. The foregoing discussion should include agreeing where copies should be kept and who should have access. Breaches of condentiality should be treated in the same serious manner as disclosure of personal details of any other employee. The school may wish to obtain assistance from some of the organisations listed in the list of Helpful Organisations at the end of this guidance.
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13
Helping other staff members
Schools can make it very clear to other staff members that bullying of any transgender person will not be tolerated and is likely to result in disciplinary action. While that is very likely to prevent bullying, it may make the other staff members resentful if they are not helped to understand and accept transgenderism. Although the transgender person may not be bullied, he or she may experience isolation. This may be because of the resentment. It may also arise because other staff members are fearful of doing the wrong thing. To overcome this difculty, schools may think it appropriate to provide information and training to the other members of staff. A booklet ; Transgender Experiences is available on line; printed copies may be ordered from the Department of Health (08701 555 455), by quoting the publications reference number: 284887. Training may be obtained from several of the organisations listed in the list of Helpful Organisations at the end of this guidance.
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14
Inspirational role models
Trans people live in all walks of society and are employed at all levels: they are doctors, nurses, musicians, writers, shop assistants, professors, airline pilots, lorry drivers, and so on. Having made this transition, whether or not they have a Gender Recognition Certicate, many in this situation regard themselves as ordinary men and women. It may be helpful to pupils and to school staff to view the following photographs of trans people.
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LAWYER
System Engineer
Owner of IT Company
Sales manager
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Doctor
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15
Case examples
All names disguised
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Case examples ing she agreed to try school again, and over the next 6 months progressed to the point where she was once more in full time school. The school changed her name to her girls name on the register and the teachers addressed her by female pronouns. She had a group of girlfriends who had known her from junior school and supported her. Nonetheless, from time to time, she still felt unable to go to school, for instance following a violent confrontation with another pupil following some unpleasant name-calling. Finally, Denise refused to return to the school after an older boy shouted out insults then tried to pull her skirt down. She was then found a place at a special needs school. Because the clinic that was providing her medical care did not offer medication to suspend Denises puberty, her parents arranged for her to be treated under the supervision of the Childrens Hospital Boston, in the USA. Information about that is available at on the GIRES website. Denise is now happy at school and responding well to the medication prescribed by the American clinician.
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Case examples
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Case examples The school even thought to request (on receipt of Melissas change of name certicate, and before she made the external changes) that her GCSE certicates were issued not only in the right name, but also in the right gender. However, Melissa reported that: . . . many pupils are ignorant and cruel and they shout out things like, Girl with a cock, Theres the he/she/it, Tranny boy, and other names. On my way to school, people shout similar comments from their cars, because of the way I look. Where such malicious comments were made (mainly by younger kids to whom the school had decided not to explain the situation), the school dealt with the people involved, in line with their bullying and harassment and diversity and equality policies. Melissa was asked to go up to the abusers and ask for their names, so that she could let the headmaster know that they were harassing her. This worked a treat, although she was nervous doing itand the threat of further action from the head was enough to stop them doing it again. With regard to the external abuse, the school made sure that there was always a teacher by the school gates morning and afternoon. Melissas parents learnt, just before she left the school, that several parents had complained about their child having to be at school with her. The school basically told them that Melissa, like every other child, had a right to be at the school and to be safe and happy there and that if they had an issue with this, they were welcome to withdraw their own child from the school.
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Case examples
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Case examples Reaction from other pupils; Jake has been physically beaten up; he also remarked that he had experienced episodes of stones being thrown at him, all throughout his school life. Jake was also verbally abused; called a man beast, tranni boi, lesbian. Jake was told that unless he started being a girl they were going to get him. Jake was also threatened with a knife which he didnt report because of fear. A gay friend of Jakes had his head held under water, partially for being gay, partially because he was talking to Jake. Jake has also been beaten-up around six times. Once while in the local bus station with his girlfriend they had (again his own words) big stones thrown at us in front of security guards and the only time they said anything was when my girlfriend turned around and started swearing at them for doing nothing, the guards just told us to go away. Jake constantly gets harassed in the streets/shops/on buses, he gets asked if he is a boy or a girl; he asks them why does it matter? They then decide because his voice sounds like a males, therefore, he then gets harassed for having shoulder length hair (he would like it short but his mum would not let him cut it). Jake has lost many friendships; because they dont want people to see them with him, or they dont like queers or because they just cant understand it, they seem to think it is just a phase. Because of these experiences Jake remarks that; he has become a social-phobic, he was so scared to be near anyone; it got to the stage that at one time he had forced himself to throw up on a daily basis; so he could stay at home, away from people, which obviously has still left an impact on him, even though he feels he may now be over the worst. Jake is still very reserved and some days depending how bad his depression is, he sometime nds it incredibly hard to wake up or leave the house. He used to feel like he was a freak and he was dirty, (some of the reasons why he felt suicidal). He still nds it a struggle to communicate with people face to face.
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Case examples
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Case examples to their forms on the rst day of school in September 2004 Tom was not quite sixteen years of age at this stage. The head of year gave Toms mum her home phone number and email address and they kept in touch over the summer holidays, in case anything changed. The statements were delivered, Tom sat in with his form to listen to the statement, and there was very little adverse reaction at the time. Tom received tremendous support from his close peers and the school allocated a staff toilet for his personal use, also for changing for PE/Games. Tom was allowed to have games with the boys. Tom was taunted by a few students from higher and lower years for a short while, but the novelty wore off and those involved were warned off by his friends.For Tom, it has on the whole been a positive all round experience apart from the few verbal taunts. Tom is not a shy individual; he now plays bass guitar in a band and writes for the band. They regularly perform locally and everyone who knows about his history seems to have forgotten it and treat him as entirely male. Tom has a very strong and close group of seven or eight friends and an active social life. Toms mum did remark; that Tom and herself would have struggled without the wonderful support and bonding of Mermaids.
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Appendices
A. Consent to treatment B. Model transgender policy C. Self assessment checklist for schools D. Letter to staff E. Documents to be corrected in a change of gender role F. Prevalence, of the transgender population G. Sources of further information, advice and training H. Introduction to trangender terminology
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A
Consent to treatment Consent
It is usual for children and young people under the age of sixteen, to have the consent of an adult having Parental Responsibility (PRsee below) for them, for every stage of treatment. However, in some cases, the consent of any adult(s) having Parental Responsibility is not necessary, if the young person under sixteen is deemed, by the doctor, to be Fraser (or Gillick) competent. Competence means that the young person must understand the issues, and. . . retain the information long enough to. . . consider the information appropriately, and. . . make a decision based on the information received. After the sixteenth birthday, a young person is automatically deemed to be competent (see Family Law Reform Act, 1969, section 8). Gillick refers to a court case, Gillick v West Norfolk and Wisbech Area Health Authority (1985), in which it was stated that, in order for those under the age of 16 to be regarded as competent, the young person must have not merely an ability to understand the nature of the proposed treatment, but a full understanding and appreciation of the consequences of both the treatment in terms of intended and possible side-effects and, equally important, the anticipated consequences of failure to treat (this approach is in accordance with the Fraser guidelines). This might apply where the child and the parent (or other people having Parental Responsibility) are
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Parental Responsibility
A person with Parental Responsibility (PR) will include: the natural mother automatically; the natural father, if married to the mother at the time of childs birth or having subsequently married her, or having a section 4,1a Order or 4,1b agreement (Children Act CA 1989); anyone with a Residence Order, s8 and s12, CA 89 or a Care Order, s31, s33(3) CA 89; anyone with a Special Guardianship Order, s14A, CA 89, an Adoption Order; or a Placement Order (s22 Adoption and Children Act 2002). Under a Placement Order the Local Authority and prospective adopters share PR alongside any parents who have PR. The local authority determines the extent to which the PR of parents and prospective adopters is to be restricted (s25 Adoption and Children Act 2002). An Adoption Order will extinguish all PR held by anyone other than the adopters. Where step-parents adopt their partners children, the partner who is the natural parent retains PR (s46 3b, Adoption and Children Act 2002). In relation to births registered from 1 December 2003, a natural father who is not married to the mother of the child but whose name was entered on the relevant childs birth certicate will automatically have Parental Responsibility. Step parents may also acquire PR under s4A (CA 89). In respect of children born before 1 December 2003, a natural father may obtain PR by being entered on the relevant childs birth certicate at a later date, with the agreement of the mother.
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B
Model transgender policy
Based on the work of the Association of Teachers and Lecturers. This school/college values all its pupils and staff equally. It will neither practise nor allow any discrimination based on gender identity. Recognising the existence of transphobia in society, the school/college will ensure the following: Staff and pupils will not be denied fair and equal treatment because of their gender identity. All areas of the curriculum and resources will be closely monitored to see that they do not rely on gender stereotypes and that they contain no transphobic material. Transphobic abuse, harassment and bullying (e.g. name-calling, derogatory jokes, grafti, unacceptable or unwanted behaviour, intrusive questions) are serious disciplinary offences and will be dealt with promptly under the appropriate procedure. Staff will not be excluded from employment, promotion or any employee benet because of their gender identity. Staff or pupils who wish it to be known that they are transgender will be provided with a supportive environment. However, it is the right of the individuals to choose whether they wish to be open about their gender identity. To out someone, whether staff or pupil without that persons permission is a form of harassment, and will be treated as such.
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Model transgender policy Assumptions will not be made that partners are always of the opposite gender. Transgender issues will be included in equality training. Staff and pupils will be provided with a condential procedure for reporting any transphobic bullying. Monitoring of complaints of transphobic abuse, harassment and bullying, and of the schoolss readiness to deal with such cases, will be undertaken at least once a year. The Ofsted self evaluation form will include reference to transphobic bullying and the measures the school has in place to tackle it. Staff undergoing medical and surgical procedures related to gender conrmation will receive positive support from the school/college to meet their particular needs during that period. Transgender staff and pupils come from diverse backgrounds and the school/college will strive to ensure that they do not face discrimination either on the grounds of their gender identity or with regard to other aspects of their identity (e.g. race, age, religion, disability, belief). Overall, the school/college aims to create an environment in which all staff and pupils, whatever their gender identity, feel equally welcome and valued and in which transphobic behaviour is not tolerated.
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C
Self assessment checklist for schools
Have you: Included transgender in the schools gender equality scheme? Published a policy with regard to: providing equality for all transgender people? transphobic bullying of pupils or staff? Prepared a contingency plan to be implemented in the event that the transgender status of a pupil or staff member is about to be or has been revealed? Publicly nominated a staff member who will, in total condence, provide or obtain support, advice and protection for any pupil who is experiencing gender variance and even transphobic bullying? Established a procedure for recording all incidents of transphobic bullying against any pupil or staff member? Conducted an anonymous survey of pupils opinions about and experience of transphobic bullying? Identied the person within the local police force who should be contacted if any incident of transphobic bullying is grave enough to be considered a criminal offence?
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Self assessment checklist for schools Obtained a supply of the Department of Health booklets, listed in Sources of further information, about trans youth and their medical care, publicised their availability and promised condentiality for those who wish to obtain them? Introduced the subject of transgenderism into appropriate sections of the curriculum? Provided training for staff on transgenderism and combating transphobic bullying?
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D
Letter to staff
IMPORTANT To protect the pupil, now and in later life, the school should clearly mark any such material as strictly condential for your eyes only. The schools head teacher would, typically, wish to control the dissemination of such information outside the teaching staff for instance to other pupils. Strict condentiality of such correspondance should be maintained not only during the pupils tenure but also thereafter.
The following letter is exactly as the head teacher wrote it, apart from the change of names. The young person about whom the teacher was writing praised her school highly for the care it had taken to support and protect her. It was written before she had commenced transition or even had chosen her female name. Accordingly the teacher referred to her in her given birth name and used the male pronouns. (All names disguised) Dear Colleague, I have spent the best part of the morning dealing with a very sensitive issue that involves one of our Year 11 boys, namely Stephen Gray. During the Year 11 Parents evening, Stephens Mum sat down and informed me that he was experiencing a very difcult time in his life which may account for a decline in his performance. She then went on to tell me that it was due to a diagnosis of gender dysphoria. I was none the wiser until she explained that basically Stephen feels that he has been born in the wrong body, and that he wishes to be female.
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Letter to staff The family have gone through and are still going through a very difcult time in terms of learning to live with the decision that Stephen has made, which is one that he says that he has always questioned since he could think. They have dealt with it tremendously and deserve much praise for the support that they have provided to all involved and, although it is early days, speaking to Stephen and his Mum you get a feeling that they are now very stable and comfortable with the idea and are now just waiting to get on with all of the counselling and consultancy appointments in line to help them complete Stephens transition. Some Year 11s are now beginning to ask questions of Stephen and he has not denied anythingby the time I write this it will probably be a common rumour/knowledge in Year 11 at least. This sparked a meeting with Mum, Stephen, AAB, RBS and myself this morning in order to discuss a way forward. The upshot of it is that in the short term the following will happen: AAB and GNR will speak to Y11 together early next week to address the issue, in Stephens absence basically saying that we need to be supportive and tolerant of other peoples choices and basically get on with things without giving it too much thought. All teaching staff will receive this email and be spoken to in a little more depth about the situation during the full staff meeting on 21st March and you will be invited to comment on any issues you may have with it, if any. Stephen will continue to attend school in the knowledge that his Year and Staff are fully informed, knowing that he can speak to myself or AAB if a minority of individual students do not behave appropriately to him as per bullying procedure. We as a collective staff and pupils maintain a safe, supportive and effective learning environment for Stephen as per usual, regardless of this situation. In the long term: Stephen will attend 6th form but begin his transition to living his life as a female during his time with us. His physical appearance will not change drastically and he has assured us that he isnt going to start plastering make up on and dressing in draga smart trouser suit and longer hair will probably be all that is different in school. We are to discuss his/her known as name and when to start using it, which is likely to be Susan but this will only be once people are informed of the issues.
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Letter to staff Toilets will also be an issue and certain arrangements have been discussed but as yet not nalised. Stephen will be happy with what ever makes people comfortable, as he feels this will make him more comfortable also. I could go on but this is more than enough for you to take on board at present. I have had since October to get used to the idea and I must say that it doesnt really bother me. He/she or Stephen/Susan is still the polite, intelligent, amiable character that has been evident since Y7. It might at rst appear as a sad situation, but for Stephen it is a situation that will ultimately lead to a happier lifeand in our society we would do well to support this wholeheartedly. If you have any questionsplease do not hesitate to contact me. Business as usual please. Don
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E
Documents to be corrected in a permanent change of gender role
The list of documents and records that the trans person has to change is very long and may, for instance, include: Driving licence. Passport. Degrees and other qualications. Membership of professional societies. NHS records, E111, GP and other doctors. Other medical services e.g. Dentist, Optician. Tax and National Insurance. Personnel records at work. Security Clearance.. CRB checks. Workplace badge. Pension and life insurance records. Benets Agency. Credit history.
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Documents to be corrected in a permanent change of gender role Bank and building society. Investment records. Personal and household insurance policies. Any deeds to dwellings and land. Mortgage. H.P. Agreements. Credit cards. Utilities: Gas, Electricity, Water, Phone. Council Tax. Electoral Roll. Club memberships. Charity databases. Internet Domain registration. Birth certicate, after grant of a Gender Recognition Certicate.
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F
Prevalence, incidence and growth of the transgender population
Some policy makers use the 1998 survey of gender dysphoria that was conducted in Scotland to estimate the likely number of people affected by the condition who have sought medical care. Prevalence was then estimated to be 8 per 100,000 people aged over 15 years. A survey conducted in The Netherlands in 1996 produced similar results. However, subsequent rapid growth in the number of people presenting for medical treatment of gender dysphoria in the UK requires an upward revision of any estimates based upon the earlier data. Based on statistics derived from government sources, the number of people who have sought medical care has been growing at 6% per annum compound since 1995. Current prevalence may now be 21 per 100,000 people aged over 15 years, i.e. 10,500 people, of whom 80% were assigned as boys at birth (who may become trans women) and 20% as girls (who may become trans men). Incidence was not measured in the Scottish survey. It may now be 2.6 per 100,000 people aged over 15 in the UK. This indicates a current growth rate of 12% per annum. Figure F.1 shows an estimate of the number of people who have transitioned between gender role in the United Kingdom extrapolating from the data discussed above. The reservoir of transgender people, from among whom a small proportion are presenting with acute gender dysphoria, may be very large, but mainly hiddenpossibly 300,000, a prevalence of 600 per 100,000. Employers and service providers need to be aware of the size and special needs of the transgender population, for whom separate provision should
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Belgium Survey (3,800) Passports/DVLA (5,000) Scottish Survey (2,360) DSS (3,000)
Figure F.1: Number of people transistioned in the UK be made in their organisations diversity policies. The median age at which people present for treatment has remained steady at around 42 years. This can be seen in the accompanying gure F.2 which was produced from data in a very comprehensive survey by the NHS completed in 2007. This may indicate that the number of transgender people who may in future present for treatment is not nearing exhaustion, as might be assumed if the median age of presentation were diminishing. Accordingly, the current growth in prevalence may continue for a lengthy period. Among young people, the transgender population is even more invisible to the medical services. Very few present for treatment despite the fact that most gender dysphoric adults report experiencing gender variance from a very young age. At present, only 100 children and adolescents are referred annually to the UKs sole specialised gender identity service, compared to the 1,200 referred to the adult clinics. Nonetheless, incidence among youngsters is also doubling every ve years and would grow much more rapidly if gender variant people started presenting earlier for treatment. Schools need to be aware that it is difcult to distinguish between gender variance and atypical sexual orientation in pre-pubertal children. Pre-
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45 40 35 30 25
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Figure F.2: Median Age of transition of people in the UK pubertal children are those in whom the changes in physical characteristics generally associated with puberty have not yet started to occur. Lesbian, gay and bisexual people are now assumed by the government to comprise about 5% of the population aged over 16. Many may have exhibited gender variant behaviour in their early days at school.
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Sources of further information, advice and training Publications
Transgenderism and Intersexuality in Childhood and Adolescence[15]. True Selves: Understanding TranssexualismFor Families, Friends, Coworkers, and Helping Professionals[16]. Caring for Transgender Adolescents in BC: Suggested Guidelines Clinical Management of Gender Dysphoria in Adolescents[17]. Clinical Management of Gender Identity Disorder in Adolescents: A protocol on psychological and paediatric endocrinology aspects[19]. A guide for young trans people in the UK[13]. Medical care for gender variant children and young people: answering families questions[3]. The Transgender Child A Handbook for Families and Professionals [18].
Useful Links
UNISON guide on the rights of trans workers: Bargaining for Transgender Workers Rights.
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Sources of further information, advice and training The Amicus guide, entitled Combating Homophobia and Achieving Equality for LGBT Workers - A Negotiators Guide, which includes substantial sections on trans issues.
Helpful Organisations
The following national organisations offer trans people, their families and those who wish to help them, including schools and colleges, a wide range of resources, including information, advice, support, literature, training and assistance with policy development. They may also be able to provide details of local support organisations.
a:gender
tel: 020 7035 4253 email: email: agender@homeofce.gsi.gov.uk Website Support for staff in government depts/agencies who have changed, or who need to change permanently their perceived gender, or who identify as intersex.
DEPEND
Depend, London WC1N 3XX email: info@depend.org.uk website: Website Free, condential, non-judgemental advice, info. & support to family members, partners, spouses and friends of transsexual people.
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FTM NETWORK
FTM.Org.UK, London, WC1N 3XX. tel: (Wed, 8-10:30pm) 0161 432 1915 email: members@ftm.org.uk website: Website Advice and support for female to male transsexual and transgender people, and to families and professionals; buddying scheme; newsletter: Boys Own; annual national meeting.
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GENDERED INTELLIGENCE
email: jay@genderedintelligence.co.uk; catherine@genderedintelligence.co.uk website: Website Company offering arts programmes, creative workshops and trans awareness training, particularly for young trans people.
GENDYS NETWORK
GENDYS, London WC1N 3XX email: gendys@gender.org.uk Website Network for all who encounter gender problems personally or as family members, lovers or friends, and for those who provide care; quarterly journal; biennial conferences.
MERMAIDS
Mermaids, London WC1N 3XX tel: 07020 935066 email: www.mermaidsuk.org.uk/ Website Support and information for children and teenagers who are trying to cope with gender identity issues, and for their families and carers. Please send SAE for further information.
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SCHOOLS OUT
helpline: male: 01582 451424; female: 020 7635 0476 email: secretary@schools-out.org.uk Wesite Provides both formal and informal support network for people who want to raise the issue of homophobia, transphobia and heterosexism in education, campaigns on these issues and brings them into curriculum development.
TRANSKIDS
transkids.synthasite.com This site is primarily for teachers in primary schools. It is not just for teachers in primary schools with transgendered children in their class, it is for all primary school teachers. However there is also material here which may be useful to secondary teachers and parents.
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Sources of further information, advice and training Website Assists those troubled by gender dysphoria and involved in their care.
THE SIBYLS
Sibyls, London WC1N 3XX Website Christian spirituality group for transgender people.
WOBS
Women of the Beaumont Society BM WOBS, London WC1N 3XX tel: 01223 441246, 01684 578281 email: wobsmatters@aol.com Website
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Sources of further information, advice and training Operated by and for wives, partners, family and friends of those who crossdress.
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Introduction to trangender terminology
Gender Identity
Gender Identity describes the psychological identication of oneself as a boy/man or as a girl/woman. There is a presumption that this sense of identity will evolve along binary lines and be consistent with the sex appearance.
Sex
Sex refers to the male/female biological developmentthe phenotype. In an infant, the sex is judged entirely on the genital appearance at birth. Other phenotypic factors such as karyotype (chromosomal conguration) are seldom tested unless a genital anomaly is present. There is a presumption that an apparently male infant will identify as a boy, and vice versa.
Gender Role
The gender role is the social rolethe interaction with others which both gives expression to the inner gender identity and reinforces it. Despite the greater gender equality in modern Western culture in terms of: the subjects studied in school and at university; the choice of friends; work and domestic arrangements; dress and leisure pursuits, there is still a presumption of conformity with societys rules about what is appropriate for a man or a woman, a boy or a girl, especially in terms of appearance. Too
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Introduction to trangender terminology great a transgression often causes anxiety and discomfort in those who witness it.
Transsexualism
When gender variance is experienced to the degree that medical intervention is necessary to facilitate a permanent transition to a gender role that accords with the gender identity thus alleviating the intense discomfort, it may be regarded as transsexualism. In the United Kingdom, those who are intending to undergo, undergoing or having undergone gender reassignment, under medical care are protected in law. Those who have changed their role permanently may obtain legal recognition of their new gender status in accordance with the Gender Recognition Act.
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Transgender
Transgenderism has had different meanings over time, and in different societies. Currently, it is used as an inclusive term describing all those whose gender expression falls outside the typical gender norms; for example, those who cross-dress intermittently for a variety of reasons including erotic factors (transvestism), as well as those who live continuously outside gender norms, sometimes with, and sometimes without, medical intervention. There is a growing acknowledgement that although there is a great deal of difference between say, a drag artist and a transsexual person, there are nonetheless areas in the transgender eld where the distinctions are more blurred; for example, a person who cross dresses intermittently for some years, may later transition fully to the opposite role.
Transition
Transition is the term used to describe the point at which a permanent change of gender role is undertaken, in all spheres of lifein the family, at work, in leisure pursuits and in society generally. Some people make this change gradually, however, others emerge overnight.
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Sexual Orientation
Sexual Orientation is a separate issue from gender identity. Trans people may be gay, straight, bisexual or, occasionally, asexual. Their sexual relationships may remain the same through the transition process, or they may change.
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Bibliography
[1] Crown Prosecution Service: Guidance on Prosecuting Cases of Homophobic and Transphobic Hate Crime November 2007, page 3, 1.4 [2] Besser, M, Carr, S, Cohen-Kettenis, PT, Connolly, P, De Sutter, P, Diamond, M, Di Ceglie, M (child and adolescent section only), Higashi, Y, Jones, L, Kruijver, FPM, Martin, J, Playdon, Z-J, Ralph, D, Reed, T, Reid, R, Reiner, WG, Swaab, D, Terry, T, Wilson, P, Wylie, K (2006) Atypical Gender DevelopmentA Review International Journal of Transgenderism 9(1): 2944. 2 [3] NHS booklet Gender variance in children and young people Answering families questions: booklet available online. 4, 20 [4] Di Ceglie, D., Freedman, D., McPherson, S., & Richardson, P. (2002). Children and adolescents referred to a specialist gender identity development service: clinical features and demographic characteristics. International Journal of Transgenderism 6 (1). 8, 25, 81 [5] Teachernet: tackling homophobic bullying. 9 [6] Whittle S, Turner L, Al-Alami M, (2007) Engendered Penalties Transgender and Transsexual Peoples Experiences of Inequality and Discrimination. 12 [7] Green R. (1998) Transsexuals Children, 1998, 4. Int. J. Transgenderism, 2,. 12
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BIBLIOGRAPHY [8] Freedman, Tasker & Di Ceglie, (2002). Children and Adolescents with Transsexual Parents Referred to a Specialist Gender Identity Development Service: A Brief Report of Key Developmental Features, SAGE Publications, 7(3): 423432). 26 [9] Golombok, S [2000] Parenting: what really counts? London, Routledge. 26 [10] Cohen-Kettenis, P. T., Delemarre-van de Waal & H. A., Gooren, L. J. G. (2008): The treatment of adolescent transsexuals: changing insights. Journal of Sexual Medicine. In press. 26 [11] EOC February 2007. Meeting the gender duty for transsexual staff Guidance for GB public authorities, available online. 23 [12] The Gay, Lesbian and Straight Education Network (GLSEN), National School Climate Survey2005, page 83 44 [13] Department of Health:: A guide for young trans people in the UK. 17 [14] An electronic NHS booklet entitled Transgender Experiences Information and support is available. Printed copies may be ordered from the Department of Health (08701 555 455), by quoting the publications reference number: 284887. 19, 81 [15] Professor Peggy Cohen-Kettenis and Professor Friedemann Pffin: Transgenderism and Intersexuality in Childhood and Adolescence, Sage Publications 2003, ISBN 0-7619-1711-X; 20, 48 [16] Mildred L. Brown and Chloe Ann Rounsley: True Selves: Understanding TranssexualismFor Families, Friends, Coworkers, and Helping Professionals, Jossey Bass 1996, ISBN 0-7879-6702-5. 81 [17] Annelou de Vries, Henriette Delemarre-Van de Waal, Peggy CohenKettenis: Caring for Transgender Adolescents in BC: Suggested GuidelinesClinical Management of Gender Dysphoria in Adolescents; Transcend Transgender Support & Education Society and Vancouver Coastal Healths Transgender Health Program; January 2006; article available online at:online article. 81 [18] Stephanie Brill and Rachel Pepper, The Transgender Child A Handbook for Families and Professionals, Cleis Press Inc. ISBN 978-157344-318-0 81
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BIBLIOGRAPHY [19] Henriette Delemarre-Van de Waal and Peggy Cohen-Kettenis: Clinical Management of Gender Identity Disorder in Adolescents: A protocol on psychological and paediatric endocrinology aspects; European Journal of Endocrinology, 2006. 81 [20] Shaeffer, L, Wheeler, C (2004) Guilt in cross-gender identity conditions: presentation and treatment, Journal of Gay and Lesbian Psychotherapy 8(1/2: 117127) 81 [21] GIRES, gender variance: SchoolsYears 10 and 11. 13 [22] GIRES, Denition and Synopsis of the Etiology of Adult Transsexualism (2002) 20 20
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Index
., 47 a:gender, 82 abuse external, 61 physical, 1, 12 transphobic, 37, 69, 70 verbal, 1, 12, 14, 63 asexual, 7, 91 assault sexual, 1, 19 Australia, 22 Beaumont Society The, 85 Women of, 86 Trust, The, 85 Belgium, 22 benets corporate, 50 state, 31 Benets agency, 76 birth certicate, 39, 51, 68, 77, 91 bisexual, 7, 19, 80, 91 building society, 77 Canada, 22
changing facilities, 35, 37, 51, 52, 65 children gender variant, 18, 19, 81, 92 pre-pubertal, v, 10, 11, 15, 79 rights, 34 welfare, 34 withdraw from school, 19 working with, 39 Civil Partnership, 40 Civil Partnership Act, 91 clitoroplasty, 29 counselling, 21, 28, 74 credit cards, 77 history, 76, 83 rating agencies, 83 cricothyroid approximation, 29 Criminal Records Bureau, 39, 76, 82 cross-dress, 4, 5, 10, 87, 90 Crown Prosecution Service, 2, 92 Data protection Act, 41, 49 Deed Poll, 31 Department Children Schools and Families, 3437
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INDEX Constitutional Affairs, 34 of Health, 19, 25, 93 DEPEND, 82 disciplinary action, 36 offence, 69 discrimination, 18, 35, 46, 52, 69, 70, 92 education, iv job severance, 37 recruitment, 37 transsexualism, 34 unlawful, 47 workplace, iv, 37, 38, 41, 42, 45 documents, changing, 76 drag artist, 90 Education and Inspection Act, 36 Education Authority, 34, 50 EHRC, 44 electoral role, 77 facial feminising, 29 facial hair removal, 29 fallopian tubes, 29 Family Law Reform Act, 67 female to male, 5, 83 feminise, 21, 22, 28 FTM Network, 83 rearing, 89 reassignment, 37, 38, 42, 52, 90 role, 35, 88 assigned, 9, 24 change, 10, 11, 17, 18, 31, 36, 4648, 76 new, 2, 28, 32, 37, 46, 48, 51, 52 transition, 18, 47, 51 stereotype, 89 Gender Equality Scheme, 2 Gender Recognition Act, 39, 51, 91 Gender Recognition Certicate, 37, 3942, 45, 4951, 55, 77, 83, 89 Gender Recognition Panel, 39, 83, 91 Gender Trust, The, 86 Gendered Intelligence, 13, 18, 19, 22, 84 Gendys, 84 genital anomoly, 88 appearance, 9, 88 surgery, 40, 91 underdevelopment, 23 Genuine Occupational Qualication, 37, 46 Germany, 22 GIRES, 1820, 83 GOQ, 39, 46
gay, 7, 10, 19, 63, 80, 91, 93, 94 gender conrmation, 38, 39, 41, 43, 44, harassment 4650, 52, 70, 90 condentiality breach, 42 equality, 88 employment, 42 expression, 9, 17, 89, 90 homophobic, 17, 41 identity in employment, 37 atypical development, 10 outing, 69 clinic, 27 permitting, 37 clinics, 10 prevention, 38 development, 10 text message, 19 legal, 38, 39, 83
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INDEX transsexual, 38, 48, 69, 70 workplace, 43 Health and Safety at Work Act, 43 homophobic, v, 12, 35, 92 hormone, 90 blocker, 2224, 60 cross sex, 23 feminising, 21, 28, 46, 60 masculinising, 28 natural, 21, 23 prescribe, v, 5, 21, 27 hysterectomy, 29 National Insurance, 76 Netherlands, 22, 25, 78 NHS, 810, 18, 21, 30, 64, 76, 92 Norway, 22 oestrogens, 23 Ofsted, 70 orchidectomy, 29 ovaries, 29
paediatric endocrinologist, 24, 60, 81, 94 penectomy, 29 pension, 31, 42, 49, 51, 76 insurance, 49, 77 occupational, 51 corporate, 50 state, 51 no valid cover, 50 phalloplasty, 29 Internet, 19, 37, 77 phenotype, 88, 89 intersex, 83 female, 90 karyotype, 88 male, 90 police, 2, 19 labiaplasty, 29 involvement law harassment, 46 common, 33, 34 policy discrimination, 33 anti-bullying, 17, 20 education, 33, 35 bullying, 17, 61 human rights, 33 condentiality, 45 lesbian, 7, 10, 19, 63, 80, 93, 94 diversity and equality, 61 harassment, 45, 61 male to female, 5, 52 zero tolerance, 48 mammoplasty, 29 leave and absence, 48 married, 40, 91 uniform, 36, 51 masculinise, 21, 28 Press for Change, 84 mastectomy, 29 prevalence, 78 media, 49 psychological, 88 medical assessment, 21, 22, 25 intervention, 89 tests, 22 treatment, 4, 5, 10, 21, 23, 31, well-being, 26 39, 40, 47, 49, 78, 91 psychopathology, 24 timescale, 47 puberty, 8, 15, 2123 Mermaids, 18, 20, 64, 65, 84 changes, 10, 24 metoidioplasty, 29
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INDEX full, 60 onset, v, 8, 11, 22, 23 suspend, v, 2325, 59 unwanted development, 8 reproductive organs, 3 regain capacity, 23 Rights of the Child, 33 Royal College of Psychiatrists, 23 salpino-oopherectomy, 29 School Bully on Line, 85 Schools Out, 85 Scotland, 78 Scottish Transgender Alliance, 86 scrotoplasty, 29 Secretary of State, 34 security checks, 49 Security clearance, 76 Sex Discrimination Act, 38 sexual relationships, 91 Sibyls, The, 86 single-sex, 35, 36, 51 sperm, 23 spermatogenesis, 23 Standards in Education, Ofce for, 33 Statutory Declaration, 31 suicidal, 24 surgery corrective, v, 5, 2224, 28, 30, 47, 70, 90 tax, 76 Teachernet, 12 testosterone, 23 thyroid chondroplasty, 29 toilets, 14, 19, 35, 37, 44, 51, 52, 60, 65, 75 trans man, 5, 7, 23, 28, 29, 78 trans woman, 5, 7, 23, 2729, 46, 78 transgender parent, 26, 31 pupils, 12, 35 Transgender Experiences, 93 transition, 90 transphobia, 1, 17, 26, 69, 85 transphobic, ivvi, 1, 2, 12, 19, 35, 69, 70 bullying, 1, 2, 12, 35, 70 transvestism, 90 uniform, 35, 36, 58 United Kingdom, 5, 8, 9, 2225, 89 principal clinicians, 24 United Nations, 33 urethroplasty, 29 USA, 22, 25 vagina surgical construction, 23 vaginectomy, 29 vaginoplasty, 29 violence, 1 criminal, 19, 20 vocational training, 38 WOBS, 86
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